Blog, Chirosecure Live Event June 24, 2024

Chiropractic Malpractice Insurance – Tools for Where and When to Adjust

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Hi, I’m Dr. Mark Studin, and first I’d like to thank ChiroSecure for the opportunity to share today. And share our information with you. And today I’m with Dr. Don Capoferri from Atlanta, Georgia. Hey, Don, good afternoon. Hey, Mark. How are you? I am great. It seems like quite a bit of this venue in cyberspace.

Yeah. Life is good. Thank God for technology. Don, we went to school over 40 years ago, both of us, and we’ve really seen a lot of changes in research and technology. The good news is chiropractic still works, but thankfully today, we know why it works. The real reason why it works, and we know that there is bone on nerve.

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It’s not just, it’s not the nerve rooted to the facet level. We know all those things. We know the mechanisms, and together we’ve shared many platforms teaching that. But one of the things that we’re still pushed in a little bit of a box or a corner is how do we know where and when to adjust?

How do we know when the patient’s well? And it’s funny, I had a conversation this morning from a doctor in Pennsylvania on just that conversation. He says, Oh, I’m with the Blues and they want to know pain scales and they want to know muscle testing and range of motion. We both know that a good portion of those parameters.

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are from physical therapists working with neurodegenerative diseases or stroke. And they’re looking for that to come back, which comes back quick, which comes back very slowly for long term chiropractic. Don, how quick does pain go away? How quick when you work with the patient? Actually it goes away too fast. And if you judge whether a person needs care or not by their pain level, you’re going to have a pain practice, which pain practice, one of the symptoms of a pain practice is the patient visit, Average is very low, usually under 20 because you’re relieving, you’re an aspirin to them, and you compete with pain management, and I don’t do that.

And what’s the problem with the pain management practice from your perspective? After doing this for 40 something years. I, I think the bigger problem the scope of the problem is if you have a pain practice and you pat somebody on the back and say, look, you had 10 visits. Your pain number is a one or two or zero high five.

Then you’re reinforcing the model, the sickness model. In my opinion, one of the worst things that ever happened to healthcare is when pain became a treatable diagnosis. It’s not in my office, but it is in the world of medicine. And that led to procedures and treatments only to cover up pain. My wife is a great example.

She just had total knee replacement. She’s been suffering knee pain for over a decade. And she got a shot called Euflexa, which gave her 8 years of pain relief. For Meanwhile, the joint was deteriorating and the femur had crushed the head of the tibia 12 millimeters. And all that was going on when she had no pain.

So if you judge a patient’s health by their pain, you’re doing them a disturbance. Sam Collins from H. J. Ross, which I consider probably one of the most, if not the most, knowledgeable in coding in our industry. says that a pain diagnosis is a throwaway diagnosis. Yeah, and I couldn’t agree with them more.

I agree. So we want to get to the underlying cause of the pain. It’s funny when we went to school, DC stood for doctor of cause. Remember that? Oh, you’re a doctor of cause, and I’m sure that brings you back to God knows how many years ago. But we always look for the underlying cause. Now, we’re so busy treating segmentally.

The low back hurts, I’m going to treat the low back. The neck hurts, I’m going to treat the neck. And forgetting where to look for the ultimate ideology. So when we look, and I’d like to dissect a little bit of muscle testing and range of motion. With range of motion, The range of motion is usually limited by two things.

Number one, it’s limited by muscle spasticity. And number two, it’s listed by meniscoid entrapment at the facet level. And if you don’t know what that is, you really need to attend one of our primary spine care courses. Actually, the next one is coming up. They’re all online at teachdoctors. com, but the next live one is November 2nd and 3rd.

But it’ll be our 16th one, but we’ve handled this so many times. Where through either repetitive microtrauma or a single macrotrauma, like a car accident, a slip and fall, a sports injury, sitting on your wallet over and over again, or putting a handbag on your shoulder and letting that drag down.

There’s a spacer between the facets. and when it dislodges and it goes out of position, the spacer, you lose the spacer, and the facets approximate. And as a result, the nociceptors on the facet, along with the joint capsule, which is now elongated, actually has fascinian corpuscles, which are your stretch receptors, your raffini, actually, your fascinian corpuscles, which are your crimp receptors, your raffini corpuscles, which are your stretch receptors, along with Golgi tendon apparatus, along with the nociceptors on the facets, feeds into the dorsal ganglia.

Throws over into the deep paraspinal muscles, which through positive ion channels sends information back into the dorsal ganglia, up the spinal thalamic tract, through the periaqueductal ray area, hits the thalamus, ping pongs off a myriad of areas, and creates disparate pain in different areas, so your body creates homeostasis, because you have to be plumb here, and your belly button, so you can’t be crooked.

www. circlelineartschool. com Even if it’s a debris or two. So the body tells the muscles to go in spasm. So you’re now plumb. So you’ve got spasticity all over the place. In addition, there is a direct cause and effect to muscle spasticity with this stuff. And the muscle spasm comes quickly and goes quickly.

When you replace that meniscoid, Through the adjustment you’re actually fixing the underlying cause of the problem. Now, when we do that, how do we measure, what did you learn in school, Donna? Forget in the past five or six or seven years. What did you learn in school how to analyze the spine on a day to day basis?

That’s a very interesting question. Considering the school I went to possibly the worst diagnostic education on planet Earth. And the faculty and the administration of that school Actually had us practice patient interaction without asking a person how they felt because we weren’t supposed to talk about symptoms.

That was the school I went to. Interestingly enough, when you spoke to these same people about their own practice, the only thing they had to point to patient progress was symptoms. Nothing else to point to it. Nothing to measure. You can’t show a patient what you’re feeling with your fingers. You are the only one that can assess that.

I was taught to go by palpation, period. In fact, more specifically, muscle palpation. Yeah, we were to, and I went to what was considered one of the best schools in the country, which is New York Chiropractic College, and guess what? We were taught almost the same thing. Palpation . That was that. I’m pretty sure that the administration from my school came from yours, so I’m pretty sure it was pretty close.

It’s funny when we went to school, we didn’t have really anything. And the good news is chiropractic work. We, we played the piano. We start at the sacrum and you work your way up to the cervical spine and did that, and you took whatever the body gave you. So, we’ve become a little bit more sophisticated in spinal analytics.

Now, there are very sophisticated programs out there and like CBP, Chiropractic Biophysics, There’s a posture race got some interesting stuff. There’s other stuff and it’s really good stuff, which is a little bit complicated, but it’s really good to help you understand what’s going on with the human body.

But Don, you’re involved in a program with me that really has been a game changer in creating a simplistic level of creating an accurate spinal analytic scenario. And it’s called Synverti. It’s an x ray digitizing program. And there’s a lot of programs out there in x ray digitizing that only look at AOMSI, alteration motion segment integrity, which this does also.

But from my perspective, it’s really not the most beneficial thing, but it’s really changed how we do things. Now, It does involve x ray. Don, how dangerous is x ray? Not dangerous at all. And do you remember the numbers, how many x rays you could take in each spinal level? I think it’s 5, 000 lumbar x rays on a single visit.

Necks, cervical x rays. And that’s my fault Because I didn’t have my glasses on, I didn’t see the decimal point. 500. I swear, that’s the truth. I could, I took my glasses off like this to wipe my eyes when I typed and I put my glasses, I didn’t look. But, it doesn’t matter, it doesn’t change the outcome.

It’s 500 cervical x rays. 67, 67 thoracic and lumbar, 5, 500. When’s the last time you, me, or any chiropractor in industry in one setting took a minimum of 500 x rays on the cervical spine? Never. I’ve been in practice 42 years and I’ve never taken that many x rays on any individual patient ever.

So yeah, and it’s not taught. It’s not inherent within our training, and x rays are also not cumulative, which you do today, tomorrow, the next day. It doesn’t add up. So we know, and also as far as intra and intra and inter rater reliability. There’s close to 100 percent consensus with x ray, where with motion and static palpation, it’s poor and failed and 3 percent and 6%.

So x ray is exceedingly liable. We’re using this tool, and by the way, the tool, just to be very clear, The tool does not tell you what to do. It doesn’t tell you what to do. It’s a measuring instrument, but it gives you a guideline for you, the doctor, to make a clinical decision on what to do. Would you say that’s about the most accurate statement?

Yeah, it’s like a lab test to an internist. The lab test doesn’t tell them what to do. It tells them what the person’s state of their blood chemistry is today. That’s all. Our machine, our tool, tells us what the biomechanical state of that person’s spine is today. Once you intervene, Now that biomechanical thing can change.

All right. So tell me how in your practice, you use this tool with your patients on an everyday basis and what the, why don’t you explain what the tool is actually? S Y M V E R T A. If you are curious, go to Synverta. com and check us out. I call it a biomechanical software platform. Because it does do the AOMSI, if you don’t know what that is, that’s Alteration of Motor Segment Integrity.

It kinda is in the personal injury space, so it does that very well. In fact, we’re the only ones Report on translation pathology for C1 and C2. We’re the only ones that do that. And Don, one second. Just so that this is not an advertisement for Synverta. That’s not the purpose of today. You could take a plain film and do it yourself.

You could. All this tool does is it measures for you. You could do this yourself. So explain what this does so they can do it themselves if they choose. Thanks. The one part of Synverta that’s difficult to do without a software program, I don’t necessarily think it’s just this software, is Synverta. Thanks.

The process works like this. We take, let’s just take cervical spine. I take four cervical spine x rays, A to P open mouth, lateral neutral, flexion extension, and I plot points on the bodies of the vertebrae, starting at the bottom, going to the top, and Symberta will then measure the motion of each segment and its relation to the segment above and below, and it reports on that.

More importantly, in my opinion, than telling me where And how, it does tell you how to adjust if you want to file Obligated to file that. Explain what you mean by how? A line of drive, superior to inferior to superior, or rotational pathology It’ll tell you to adjust on the left side of T7 and on the right side of T3 it also give you what a primary lesion looks like compared to compensations.

That might take a little bit of training that’s probably the most complicated part of SIMVERTA so every person, regardless of whether they’re five years old or a hundred years old in my office, gets a biomechanical study. Then that is the baseline. I treat based on the information. I adjust based on the information that I get from that.

And in 30 days or 12 visits, we take another Synverta study to see what I’ve accomplished. And the new x ray study does not at all depend on how they feel. 99 percent of the time their symptoms are greatly diminished. But whether they continue at the same schedule, at a lesser schedule, or are discharged, depends upon the biomechanical study.

And patients get very excited about seeing the updates. They get very excited about it. And because you’re x raying every 30 days, now some people do 30 days, 60 days, some people choose to do 90 days of the clinical decision. We don’t worry about negative sequelae from x ray because there isn’t any.

There isn’t any. So in, in, no, go ahead, mate, you’re frozen, can’t hear you. So what we look for when we do this is we’re looking actually for patterns. And you’re looking for patterns in rotation, patterns from inferior to superior. We’re looking for all of these different things, which will help you make a clinical decision of when to adjust your patient and where to adjust your patient.

So you can make that decision on how to move forward. And that’s really important because, when you’re doing when you’re looking at normal muscle tests and range of motion, the problem isn’t too little range of motion. The problem is too much range of motion when you have excessive motion, because what occurs is when the ligament overstretches, the ligament is made up of collagen and elastin.

So when the ligament overstretches, it tears actually, because there’s only a 0. 78 to a one millimeter, 0. 78 to a millimeter is not a lot of given that ligament. It’s got contractile an expansive ability, but when it goes beyond that threshold of a millimeter, it tears. And when it tears, and again, we’re sorry about Dr.

Capaferri he lost his bandwidth and he’s gone. So you’ll have to suffer with me for the next 10 minutes or so. So when the ligament overstretches and tears, it wound repairs, it heals. It doesn’t heal, actually, it wound repairs. So collagen and elastin are in there. And how the body wound repairs, it can only replace collagen.

Because what occurs is those fibroblasts from new, from a neonate, from the newborn, those fibroblasts, when they’re growing, stop making new ligaments. So when the fibroblasts go and make new ligaments, the body’s growing and it’s growing. Then when you hit puberty, those fibroblasts stop producing new ligaments.

Now it stays dormant. So when you have a tear, which in the ligament, literally A tear. Okay. And most we deal with is partial tears, not tool thicknesses tears, partial tears. So when you have a tear it now, so when you have a tear, so hang on, let me just finish this off. So when you have a tear, the ligament starts to wound repair, and now you only have collagen.

It’s no longer replacing elastin. So over a period of time, that wound repair creates a permanent problem. And Don, I was talking, I was leading up to, I just talked about the collagen and elastin wound repair. So when you have that you’re now creating a negative pattern and it can never be fixed. So that’s when you know your patient has gone from corrective care to maintenance care, to maintaining it.

You can’t correct it. Let me rephrase it. I don’t want to use the word maintenance. I want to use the word management. You’re managing your case just like they manage diabetes and high blood pressure. Okay, you can manage it, but once you have it, you got it. So once you have this wound repair and it’s been there.

Don, you’re going to look at a pattern, say cervical, thoracic, lumbar, and it’s based upon how much rotation at the apex of the curve that’s aberrant. Okay, that’s or pathologically rotating. If you see that pattern and it’s not normalizing in your SINVERTA report or your biomechanical study, at what point in time do you say, that’s chronic and I have to manage it, versus it’s, it got better and it’s biomechanically stable? Any positive findings, whether it be in rotation, whether it be in AOMSI translation, or angular deviation, all of those pathologies are permanent. The point is though, if you get them early on, can’t you fix that? No, the tissue damage is permanent. Ligaments do not heal. They don’t heal in one year olds.

They don’t heal in a hundred year olds. They scar. So the function of that tissue is permanently compromised. When I get a Synvertis study, I treat, I adjust based on the rotation, But when we do a follow up, we always go back and revisit the AOMSI, and what we’ll find is the extremes of hypermobility in AOMSI tend to mitigate.

and come into line with the ones that aren’t hypermobile. And essentially what you’ve done is rebalance that spine. Once that happens, a person goes on management care. I’m going to use that by the way. I like that instead of maintenance. I think we’re going to create that buzzword in the industry. We’re going to get, we’re going to talk at biomechanical pathology management.

Management. Perfect. I like that because we’re managing the spine. And, why is that important versus maintenance care? One, carriers don’t consider maintenance care just from a financial perspective. But two, we’re now in line with what’s usual and customary in healthcare. I’ve heard this, and you’ve heard this, Don, are you a medipractor?

Are you practicing medicine as a chiropractor? Have you ever heard of that? I have not heard that because I don’t usually socialize with other chiropractors except you. . It’s sad. . No, but I’ve been called that before. I’ve been called everything, you name it, I’ve been called it the medic call me names the chiros.

Call me. But here’s the thing, I stop I believe that you have to use the word words. Chiropractic, spinal adjustment. You have to Non-negotiable. We don’t manipulate non-negotiable. But when we talk about subluxation. And, look, I come, both of us come from a very strong subluxation background, both of us, okay?

And, I was a high volume practitioner, families, kids, you name it. But, when I would talk to the surgeons in the primary cares that I work with, they look at me like I have five heads. What’s wrong with you? We don’t use subluxation. You mean the bone sits on the shoulder, and then they would smile and they shake my hand.

They call me an idiot in the back of their mind, and they never work with me again. When I change my language, and I said we treat biomechanical pathology, which is subluxation. It’s synonymous. All of a sudden, the light bulb went off in their head. And they said, you know what? He said we understand that and we get it.

And it’s, but we don’t know who treats that, but you do. And all of a sudden referrals skyrocketed. So what I rather hold on. To my lexicon of subluxation, and I’m not saying don’t teach it. Don’t understand it. Don’t know it. You’ve got to. It’s part of our history. It’s what we do. It’s how we, it’s what we treat.

And I get it. But in our communication, if I held on to that, and truthfully I’m a numbers guy. I’m a big numbers guy. And I could tell you. Then I’m just looking at statistics that about, for the first, I started taking statistics in 2012, for the first 2012 to about 2020, we got about 900, 000 referrals with doing things like Synverta, doing things like working with attorneys and patients.

It was great. Once I changed that language in under four years, We picked up over a million referrals. We’re at 1, 935, 282 referrals as of today. So that number skyrocketed in part, not in whole, but in part, because we’re dealing in language that’s consistent with mainstream. So would I rather hold on to something and see a quarter of the patients?

Or do the exact same thing with my unique chiropractic spinal adjustment and talk about something people can relate to and now all of a sudden in our lifetime see the masses and those numbers explode. I don’t know what your feeling is. Wow, that would be great. Here’s the problem. When you say subluxation to a medical doctor, they hear dislocation.

And the thought that you would adjust that picture, Mark, how nauseous you would be if somebody showed you a Synverta study and C1 was moving five millimeters and this person was cracking that person’s neck. You’d want to throw up, right? That’s how they are when we talk about subluxation. It’s, if they would take me and plant me in a country where I don’t speak the language and I don’t speak any other language but English and some people think I have a hard time with that.

So you have a good opportunity if you don’t know any words in this language of offending somebody or being misunderstood and that’s what it was like for us when subluxation. So you experienced the same thing? Oh, absolutely. Now, since you changed your language and your credential, highly credentialed, I’m not going to get into you’re a fellow in primary spine care and biomechanics and spinal trauma, so you’ve really advanced your credentials through medical academia, and if someone wants to learn more, they’re more than welcome to call me, but through changing your language and using this tool, you’re Do medical doctors or surgeons reach out to you?

Oh, yeah, my best referrer is an extremity orthopedic surgeon. That’s counting my patients and counting attorneys and counting everybody. My best referrer is an orthopedic surgeon. Why? One, I worked with him in one of my fellowships and It’s really a great marriage. People come to an extremity orthopedic surgeon with hip pain, he examines them and says, it’s not your hip, it’s your back, go see Don.

And people go to him with shoulder pain. He says, it’s not your shoulder, it’s your neck, go see Don. Or if it’s their shoulder, he’ll treat them, right? But if he finds it’s originating from the spine, he sends them to me. It’s funny Dallas and Louisiana, who’s also a fellow in primary spine care, was working with a neurosurgeon.

And I spoke to the neurosurgeon many times. We’ve become pretty close and he said, working with this digitizing tool, the Subverta tool is a game changer for him because now all of his spinal cases. Most of them, he starts with Dallas and Louisiana and Monroe, Loui I think it’s East Monroe somewhere, I don’t know.

Somewhere that Louisiana don’t really care about. But he said he sends them all there first, because why should he waste his time, evaluating these people if they’re going to be non surgical, which is like 99 percent of them. They all go there first. Mark, what’s the parent company of the Blues?

What’s it called? I don’t know. Huh? No, there’s a parent company over there. Anyway, they I got an email from that company because I have a policy with the Blues and it delineates if a surgeon is a spine surgeon what criteria will force him to do fusion versus an artificial disc. And Symbird is perfect for that because it states right in there.

If there’s more than 3. 5 millimeters of translation, you have to fuse. You can’t use an artificial disc. If there’s more than 11 degrees of angular deviation, you have to fuse. You can’t use an artificial disc. And Symbird, it does all that for the surgeons that you know, or maybe you’re on here and you’re a surgeon and you want to get that tool.

That’s how you do it. And you work with a doctor who will do it. It’s just, oh, that’s one of the things we do, but it really takes all the guesswork out. There is no longer, it’s not hunt and peck anymore. There’s no more guesswork. And do you know who really likes this the best?

The malpractice companies, because it really gives, and insurance companies, actually, insurance companies don’t know what to do with us because if there’s no muscle testing, the range of motion, they want to deny it. You can’t refute a demonstrable digitizing showing biomechanical pathology, which is evidence based.

0. 78 is the is the average of ligament pathology, that’s how much it can expand before it tears, with a 0. 22 standard of deviation. So it goes down to 5, 6 or up to 1. So we consider a 1 millimeter the baseline. We err on the 1. More side. Yeah, Don? No, I was just seeing if my camera was still working.

All right, so we err on the higher side in one millimeter, of where and by the way we did a Huge dive into the literature. Huge. It took almost, I would say it was close to a two year study working with doctors around the country looking in the research to come up with this. There’s a lot of issues going on that are that go behind this, but it’s all evidence based.

And the statistical what’s the word when you test it to make sure it’s correct? We use the line that’s called the line to and from, which you put the number in. Oh, reference line. Thank you. It’s a reference line to I can’t think of the word. You’re telling Symbirda what the millimeter length is.

You are calibrating. That’s the word. We calibrate every single test. Every image, yeah. To the eighth decimal. Based upon the PAX device digital image of what we’re doing. It’s to the eighth decimal. So we’re very excited about it. Yeah, that’s pretty accurate. Calibrated to the 8th decimal. Even though we only list two, it’s calibrated to the 8th based upon what the DICOM viewer shares with us.

We’re very excited about that and that information. It’s all good. Don, listen, this was an interesting conversation. We talked about x ray. We talked about communicating. for listening. with people in the medical community so they understand what we’re doing to help build practices.

We’ve talked about chiropractic and its infancy and what it’s used. We’ve talked about muscle testing and range of motion and static and motion palpation, having poor intra rater reliability. We’ve talked about The use of digitizing, showing an extremely reliable level of digitizing and everything, it’s all there.

It’s all there for you to take. So listen, if you have any questions, you’re more than welcome to call me, call Don. I’m all over the place. You can go to Synverta, S Y N V E R T A dot com, or any of the other digitizing programs out there. We’ve named a few during this presentation. It’s not only about one pool.

There’s a lot of tools out there. So with that being said, Dr. Capofferi, thank you so much for your time. ChiroSecure again, thank you so much for the platform to share and we’ll catch you next time. Okay. Thanks, Mark.


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